Search

Background: Methods to increase treatment compliance in adolescents with cystic fibrosis (CF) is of utmost importance to improve outcomes and survival. Motivational interviewing (MI) has gained momentum as an effective strategy to address ambivalence to change in a variety of chronic health conditions and remains a promising strategy to facilitate treatment adherence in adolescents with CF. Methods: The project utilized the Plan-Do-Study-Act cycle of quality improvement (QI). A repeated measure pretest-posttest design was used to evaluate the effectiveness of a MI training. An interactive, 4-hour MI workshop was executed within a single CF center. CF care providers (N = 12) from a single CF team completed surveys evaluating knowledge, perceived importance, usage, and confidence in using MI with adolescents before and after the training. Following the MI training, care providers engaged high-risk adolescent patients using MI techniques. To determine the effect of MI on patient adherence (N = 32), markers of lung function and weight were measured before and after MI exposure. Results: Quantitative analysis of provider surveys indicated enhanced MI-related knowledge and confidence after the training. Provider usage, perception of the usefulness, and importance of using MI was unchanged. Patient-specific outcomes indicated no significant change in patient-forced expiratory volume in 1 second (FEV1), a marker of lung function, or body mass index (BMI), five months after exposure of MI in the CF clinic setting. Conclusions: This QI project demonstrates the effectiveness of a brief MI training on CF care providers' knowledge and confidence in engaging adolescents using MI techniques. Though no statistically significant differences were found in patient-specific outcomes during this brief intervention period, it is critical that longer-term exposure to MI be explored further in adolescents with CF. This study adds to a growing body of evidence supporting team-based MI trainings for CF providers. Future research focusing on patient experience and perceived benefit of MI counseling is warranted. Key Words: Motivational interviewing, cystic fibrosis, provider confidence, adherence, adolescents., Cystic fibrosis (CF) is a multisystem disease affecting the exocrine glands, primarily the lungs and gastrointestinal tract. According to the CF patient registry, in the United States, more than 30,000 [...]

There are three major social issues that are identified and discussed as major contributors to the new normal and the redefinition of deviance. They include: 1) the political rise of the extreme right; 2) the renewed urgency to address issues of social, political, and environmental justice, including and racial inequalities and inequities; and 3) COVID and its effects on society and culture. Sociologists must be key players in the identification and resolution of these issues. In so doing, we impact the reframing and redefinition of what is deviant and what constitutes the new normal.

Understanding the local-scale spatial and temporal variability of ozone formation is crucial for effective mitigation. We combine tropospheric vertical column densities (VCDTrop) of formaldehyde (HCHO) and nitrogen dioxide (NO2), referred to as HCHO-VCDTropand NO2-VCDTrop, retrieved from airborne remote sensing and the TROPOspheric Monitoring Instrument (TROPOMI) with ground-based measurements to investigate changes in ozone precursors and the inferred chemical production regime on high-ozone days in May–August 2018 over two Northeast urban domains. Over New York City (NYC) and Baltimore/Washington D.C. (BAL/DC), HCHO-VCDTropincreases across the domain, but higher NO2-VCDTropoccurs mainly in urban centers on ozone exceedance days (when maximum daily 8 h average (MDA8) ozone exceeds 70 ppb at any monitor in the region). The ratio of HCHO-VCDTropto NO2-VCDTrop, proposed as an indicator of the sensitivity of local surface ozone production rates to its precursors, generally increases on ozone exceedance days, implying a transition toward a more NOx-sensitive ozone production regime that should lead to higher efficacy of NOxcontrols on the highest ozone days in NYC and BAL/DC. Warmer temperatures and enhanced influence from emissions in the local boundary layer on the high-ozone days are accompanied by slower wind speeds in BAL/DC but stronger, southwesterly winds in NYC.

Purpose: We examined if childhood socioeconomic status (SES) was related to adult leucocyte telomere length (TL) using the data of 361 African American (AA) participants from the GENE-FORECAST Study. We also assessed the mediating role of behavioral and psychosocial factors in the association between childhood SES and adult TL. Methods: Childhood SES was assessed individually by using participant’s mother’s education and occupation, father’s education and occupation, parental home ownership, and family structure. TL was assessed using the quantitative polymerase chain reaction method. Information on potential confounders and mediators were collected. The associations of childhood SES with TL were assessed using multivariable linear regression models. We used path analysis to quantify and test the share of these associations that was statistically explained by each of the mediators (participant’s educational attainment, smoking status, physical activity, dietary habit, perceived stress, and depressive symptoms). Results: Mother’s education was associated with longer average TL (β: 0.021; 95% CI: 0.001, 0.04, p=0.038) in confounder adjusted models. Once mediators were introduced in the model, the estimates were reduced and remained marginally significant (β: 0.017; 95% CI: −0.003, 0.038, p=0.061). According to path model, approximately 19% of the effect of mother’s education on TL (β: 0.004; 95% CI: −0.001, 0.01, p< 0.10) was mediated through participant’s own education level. No significant mediation effect was observed for any other mediators. Conclusions: These data provide evidence that participant’s mother’s education was positively linked to adult TL in AA population. Participant’s own educational level partially explained this association.

A pet rabbit's behaviors--and behavior problems--are consequences of the way its wild ancestors and their captive descendants lived and survived. This article outlines the natural behaviors of rabbits and shows [...]

A drug use evaluation (DUE) technique is carried out in several hospitals to minimize pethidine prescribing in hospital emergency departments (EDs). Observations expose a persistent decrease in pethidine intake, which might point to effective encouragement of safer drug prescribing.

In 2016, Australia legislated medicinal cannabis supply as a pharmaceutical product; prescription is through two pathways dependent on product registration status with the Therapeutics Goods Administration. In 2021, down-scheduling of cannabidiol allowed for easier access through pharmacies. Little is known about the perspectives of those involved in medicinal cannabis supply regarding these legislative changes. This study captures the perspectives of stakeholders who access medicinal cannabis prior to patient provision and aims to shed light on the Australian medicinal cannabis supply process.

Rabbits are the third most common mammalian pet in the United States. They make good pets because they generally are nonaggressive and are playful, active, and curious. They form strong social bonds, both with rabbits they live with in the household and with the humans who care for them. They have several behaviors derived from their wild counterparts that can cause problems, if not properly allowed for, or be beneficial, such as their proclivity to use a specific site for elimination.

Since its founding in 1929, the Pacific Sociological Association (PSA) has undergone a variety of changes as it has adapted to shifts in society, developments in the discipline, and an increasingly diverse membership. The panelists in this session highlighted several ways in which the PSA has evolved over time and discussed a number of attempts to address the challenges facing millennials and millennial sociologists (the theme of the 90th Annual Meeting). Suggestions regarding ways in which the PSA can continue to offer support to this generation in the future were also discussed.

To explore influences on patients’ purchase and use of asthma preventer medicines and the perceived acceptability of financial incentives via reduced patient co‐payments.

Despite the alarming increase in the numbers of infants born with neonatal abstinence syndrome (NAS), little is known about the effect on the children past the age of four. Clinical findings associated with NAS are found in the literature to have a negative effect on neurodevelopmental health outcomes. The purpose of this review is to examine the current evidence regarding NAS and neurodevelopmental outcomes, identify gaps in the literature, and discuss the possible association between NAS symptoms and neurodevelopmental disorders. A comprehensive literature review of quantitative research and review articles identified human and animal studies to clarify the current knowledge on the long-term effects of opioid exposure and NAS on neurodevelopmental outcomes. The analysis found that infants exposed to opioids in uteroare at risk for poorer neurodevelopmental outcomes in early childhood; however, there is a lack of empirical evidence on the effect of NAS as children age.

The big issue used to be getting minority executives in the door. Now they're in, but can you keep them there? When the doors to Aetna Casualty and Life's headquarters [...]

The article raises awareness among parents and counselors about a legal and easily accessible drug, dextromethorphan (DXM) used by the adolescents. It mentions that drug potentially in over-the-counter cough medicines is more popular than opioids among teenagers, along with mentions the consequences of misusing the drug.

In the United States, youth involvement in delinquent and criminal acts remains persistent and increasingly violent. For at-risk youth, key demographics include poverty and distressed communities. Since traditional interventions have had limited success in addressing the needs of and issues experienced by these youths, millennials must seek new and creative techniques and programs to serve them. One such program that currently exists and provides inspiration for the future is Destiny Arts Youth Performance Company, a nonprofit, community dance group based in Oakland, CA, that offers competitive scholarships to deserving, at-risk youth in lower class, largely ethnic communities. In the ethnographic documentary, FREE: The Power of Performance, the lives of five at-risk youths are affected and transformed through the creative medium of dance. It shows that for at-risk, diverse teens, collaborative art can be a foundation for personal strength, liberation, and hope.

Identity theft is a rapidly growing crime that has reached the hallowed halls of academia. Identity thieves have targeted U.S. Department of Education federal student aid programs, with a potential [...]

Use of secure messaging through patient portals has risen substantially in recent years due to provider incentives and consumer demand. Secure messaging may increase patient satisfaction and improve outcomes, but also adds to physician workload. Most prior studies of secure messaging focused on primary care and medical specialties. We examined surgeons’ use of secure messaging and the contribution of messaging to outpatient interactions in a broadly deployed patient portal. We determined the number of clinic visits and secure messages for surgical providers in the first 3 years (2008–2010) after patient portal deployment at an academic medical center. We calculated the proportion of outpatient interaction conducted through messaging for each specialty. Logistic regression models compared the likelihood of message-based versus clinic outpatient interaction across surgical specialties. Over the study period, surgical providers delivered care in 648,200 clinic visits and received 83,912 messages, with more than 200 % growth in monthly message volume. Surgical specialties receiving the most messages were orthopedics/podiatry (25.1 %), otolaryngology (20.1 %), urology (10.8 %), and general surgery (9.6 %); vascular surgery (0.8 %) and pediatric general surgery (0.2 %) received the fewest. The proportion of outpatient interactions conducted through secure messaging increased significantly from 5.4 % in 2008 to 15.3 % in 2010 (p< 0.001) with all specialties experiencing growth. Heart/lung transplantation (74.9 %), liver/kidney/pancreas transplantation (69.5 %), and general surgery (48.7 %) had the highest proportion of message-based outpatient interaction by the end of the study. This study demonstrates rapid adoption of online secure messaging across surgical specialties with significant growth in its use for outpatient interaction. Some specialties, particularly those with long-term follow-up, interacted with patients more through secure messaging than in person. As surgeons devote more time to secure messaging, additional research will be needed to understand the care delivered through online interactions and to develop models for reimbursement.

Business Continuity is about deliberate, diligent preparation for a wide range of possible events that could lead to a business disruption and negatively impact the enterprise. The impact can be [...]

Supplemental Digital Content is available in the text.

To create a database of refrigerated medications along with comprehensive data on their stability when stored outside the recommended conditions; and to develop an educational tool for managing cold chain emergencies at the hospital. Phase 1: a searchable database was created with fields on product stability, stored temperatures and storage conditions. Phase 2: the database was populated with the products' stability data from various sources, such as literature searches, approved product information and pharmaceutical companies. Phase 3: focus groups were held with the hospital's stakeholders (nurses, pharmacists, pharmacy technicians) to develop an educational tool for managing cold chain emergencies. Of the 36 pharmaceutical companies contacted, 29 responded (response rate 81%) and provided ‘extra’ stability data for 28 products (n = 150; 19%). Pursuant to issues raised by the pharmaceutical companies about concerns of breaching the registration conditions of their products and misinterpretation of the provided in‐house stability data, a stakeholder meeting was held with the Therapeutic Goods Administration. At the meeting, the need for short‐term ‘end of shelf life’ real‐time stability studies for refrigerated products was discussed. An educational tool was designed based on a survey of local practices at the hospital pertaining to monitoring refrigerators used to store medications. Creation of the database has resulted in a critical analysis of the existing stability data on refrigerated medications. Hospital staff lack guidance on the selection, monitoring and maintenance of refrigerators used to store medications, and to manage cold chain emergencies. There is an opportunity for professional pharmacy organisations to provide this guidance.

Using the Counselor Trainee Attitudes Measure (CTAM) to assess student attitudes toward alcohol and other drug abuse (AODA), results indicated that students had more positive attitudes toward AODA when they were in recovery or had a family member in recovery. Furthermore, completion of AODA related courses predicted more positive attitudes toward AODA. Undergraduate versus graduate standing also appear to play a role in model adherence.

The historical evolution of the rehabilitation profession is addressed, and current issues facing rehabilitation educators and professionals are identified. Clearly, both our practice environments and our consumers are continuously evolving and becoming more diverse. Simultaneously, a need exists to be seen as a stable, unified profession. Specific issues including the continuing development of private rehabilitation licensure and accreditation, increasing consumer diversity, and movement toward evidence-based practices are identified as critical issues for rehabilitation educators and professionals.

Cancer clinical trials have been based on low accrual rates. Barriers to recruitment of minority populations affect the generalizability and impact of trial findings for those populations. The authors undertook a mixed‐methods approach to understanding levels of awareness and experiences with cancer clinical trials. A survey was administered to new cancer patients and their caretakers (family, close friends, or other social support) at outpatient oncology clinics. Field observations of the trial accrual process also were conducted by employing the grounded theory approach in qualitative methods. Comparison of survey results for Asian‐American respondents and non‐Asian respondents indicated that Asians were less likely to have heard the term “clinical trial” and were more likely to define a clinical trial as “an experiment” or “a test procedure in a clinic” than non‐Asians. Asians were more likely to have employer‐based insurance and to report understanding issues related to cost reimbursement. Asians were less likely to have been involved in or to know someone in a trial and reported less willingness than white respondents to consider trial participation. Qualitative observations suggested that Asians who presented for a potential trial were interested in the availability of a novel cancer therapy but were not eligible for available trials. Multiple strategies will be necessary to enhance awareness of and experience with accrual to cancer clinical trials for Asians, including richer understanding and increased involvement of Asians in cancer clinical trials and greater attention to the location and diversity of the Asian population in structuring study centers and evaluating trial results. Cancer 2005. Published 2005 by the American Cancer Society.

An increasing body of research work has made it clear that, while Felis catuscan survive in the solitary state, social groups with an internal structure, are formed whenever there are sufficient food resources to support them. Most people who have cats have two or more cats. Failure to understand what will promote either friendly or aggressive behavior can lead to various behavior problems, including aggression and conflict over resources, such as food, resting sites and litterboxes. An understanding of the natural social organization, relationships and communication between cats is therefore essential, and is the subject of this paper.

Letters to the editor are presented in response to articles published in the March 7, 2011 issue including "A Soldier's Tragedy," "Healing the Hurt" and "As Goes Wisconsin...So Goes the Nation."

Background.Results are reported from a large randomized trial designed to increase fruit and vegetable consumption among callers to the National Cancer Institute's Cancer Information Service (CIS) (n= 1,717).

The consideration of assistive technology devices and services is required during the development of every Individualized Educational Program (IEP) according to the Individuals with Disabilities Act, Amendments of 1997 (IDEA'97). Assistive technology devices and services, which the IEP team determines are required by a student in order to benefit from a free appropriate public education (FAPE), must be written into the IEP. Despite this requirement, mere has been no agreed upon description of high quality assistive technology services. This article describes the activities of a national group of assistive technology professionals known as the Quality Indicators for Assistive Technology Services (QIAT) Consortium. The QIAT Consortium was formed to initiate a nationwide dialogue regarding quality indicators for a variety of assistive technology service areas. The work of the Consortium to date is discussed and the current set of indicators is included. Processes used in the development of the indicators are described. Implications for future use of the indicators and future development activities are discussed.

We describe a case of hepatic hemangioendothelioma that was first suspected based on prenatal sonographic findings at 19 weeks' menstrual age. At 16 weeks, the patient presented with a markedly elevated maternal serum α-fetoprotein level. Serial sonographic examinations revealed that the fetus had cardiomegaly, hepatomegaly with a hepatic mass and dilated intrahepatic vessels, a single umbilical artery, and a placental chorioangioma. Arteriovenous shunting within the hepatic mass was seen using color Doppler and pulsed Doppler sonography. An enlarged artery arising from the abdominal aorta supplying the mass was demonstrated. Postnatal physical examination and radiologic studies supported the diagnosis of hepatic hemangioendothelioma. The evolution in the sonographic appearance of this hepatic lesion in utero over a 17-week period is described. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:258–263, 2000.

Cats form social groups in which individuals recognize each other, and the cohesiveness of the group is maintained by a variety of amicable behaviors. Agonistic behavior may occur between group members and between group members and nongroup members. Within the domestic environment, agonistic behavior may become a problem when it is directed at housemates or humans. Differential diagnosis and treatment of various problems of aggressive behavior are discussed.

The feeding and drinking behavior of 11 mares and 15 foals living on pasture with free access to water was recorded during 2,340 15-min focal samples taken over 2 yr. Lactating mares on pasture spent about 70% of the day feeding. Foals began feeding on their first day of life. As they grew older, they spent progressively more time feeding, but still spent only 47 ± 6% of the time feeding by 21 wk of age. Foals fed primarily during the early morning and evening. While grass formed the major proportion of the diet of both foals and mares, they also ate clay, humus, feces, bark, leaves and twigs. Almost all feeding by foals was done while their mothers were feeding. Movement to water sources was frequently, but not invariably, carried out by an entire herd. Frequency (P=.005) but not duration (P>.05) of drinking bouts by mares increased as the temperature increased. Frequency was greatest at 30 to 35 C, at which temperature mares drank once every 1.8 h. Frequency of drinking varied with the time of day (P<.01), being rarest during the early morning (0500 to 0900 h eastern daylight time) and most frequent during the afternoon (1300 to 1700 h). Drinking by foals was very rare. The youngest age at which a foal was observed to drink was 3 wk, and 8 of 15 foals were never observed to drink before weaning.